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Aging

The face of aging America has changed dramatically in recent years. As the baby boomer generation enters the golden years, people are living longer and healthier lives. In fact, life expectancy has shot to age 85.

Definition

The United States is on the brink of a longevity revolution.

By 2030, the number of people age 65 and over is projected to be about 71.5 million, of which nearly 10 million will be 85 or older. Not only are people living longer, recent research has shown that most older Americans report better health, greater wealth, and higher levels of education than older people in the past.

But the growing number and proportion of older adults place increasing demands on the public health system and on medical and social services.

Because we are living longer, we can expect to spend more time in retirement than previous generations did. Most financial planners recommend preparing for the future with a combination of Social Security, private pensions, and personal savings. Social Security currently pays the average retiree about 40 percent of preretirement earnings if they retire at age 65. Experts estimate that retirees will need, on average, 70 percent of their pre-retirement income (90 percent or more for lower earners), to maintain their standard of living when they stop working.

Though today's older Americans are living longer and healthier lives than any previous generation, many Americans fail to make the connection between undertaking healthy behaviors today and the impact of these choices later in life. Research has established that there are both physical and mental advantages to physical exercise. Moreover, screening programs can lead to preventive measures and early treatment, which can substantially reduce the impact of illnesses. A healthy diet is equally important. Nutrition influences the progression of many diseases, and studies have shown that good nutritional status can reduce the length of a hospital stay.

Many assessments of the quality of life of older Americans tend to focus primarily on financial and health aspects. However, second and third careers, lifelong learning, leisure pursuits, voluntary work, and caregiving are also issues of importance that are sometimes neglected when planning for the future.

Symptoms

Although the risk of disease and disability clearly increases with advancing age, poor health is not an inevitable consequence of aging.

Chronic diseases such as heart disease, stroke, cancer, diabetes, and arthritis are the most common and costly health conditions of old age. They exact a particularly heavy health and economic burden due to associated long-term illness, diminished quality of life, and greatly increased health-care costs.

Hearing and vision problems are also frequently encountered and are often thought of as natural signs of aging. However, early detection and treatment can often prevent, postpone, or lessen some of the debilitating physical, social, and emotional effects that these impairments can have on the lives of older people.

Mental disorders experienced by older adults may differ from those experienced by younger people, which can make accurate diagnosis and treatment difficult. For example, an older person who is depressed may be more likely to report physical symptoms such as insomnia or aches and pains rather than feelings of sadness or worthlessness. Many physicians and other health professionals may not provide effective mental-health care because they receive inadequate training in the diagnosis and treatment of mental disorders in older adults.

Furthermore, mental disorders represent a grave threat to the health and well-being of older adults. Older adults are disproportionately likely to die by suicide. Comprising only 13 percent of the U.S. population, individuals age 65 and over accounted for 18 percent of all suicide deaths in 2000. White men age 85 and older are especially vulnerable, with a suicide rate five times greater than that of the general population. Mental disorders can also negatively affect the ability of older people to recover from other health problems. Research has shown that people with depression are at greater risk of developing heart disease. Furthermore, people with heart disease who are depressed have an increased risk of death after a heart attack compared with those who are not depressed.

The occurrence of Alzheimer's disease (AD) is not a normal development in the aging process. AD is characterized by a gradual loss of memory, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impaired judgment, an inability to plan, and personality changes. Over time, these changes become so severe that they interfere with an individual's daily functioning, resulting eventually in death. While the disease can last from three to 20 years after the onset of symptoms, the average duration is eight years.

Alzheimer's disease affects as many as four million Americans. The disease usually begins after the age of 60, and risk increases with age. Most people diagnosed with AD are older than 65. However, it is possible for the disease to occur in people in their 40s and 50s. Research has shown links between some genes and AD, but in about 90 percent of cases, there is no clear genetic link. Early and careful evaluation is important, because many conditions, including some that are treatable or reversible, may cause dementia-like symptoms. Examples of such treatable medical conditions are depression, nutritional deficiencies, adverse drug interactions, and metabolic changes.

Being "down in the dumps" over a period of time is not a normal part of growing old. But it is a common problem, and medical help may be needed. For most people, depression can be treated successfully. Talk therapies, drugs, or other methods of treatment can ease the pain of depression.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression are much more likely to be dismissed as crankiness or grumpiness. Depression can also be tricky to recognize. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for high blood pressure or heart disease. Depression can happen at the same time as other chronic diseases. It can be hard for a doctor to diagnose depression, but the good news is that people who are depressed can get better with the right treatment.

Causes

Aging is a natural process, but a healthy lifestyle can do much to slow the degeneration of body and mind. The treatment section below contains more specific information on preventive measures.

Treatments

Many chronic conditions can be improved, if not cured, by treatment and/or medication, and so it is always worth seeking the advice of a doctor.

Many people mistakenly believe that mental disorders like depression or dementia are normal in older people and that no effective treatments are available. Another myth suggests that older people cannot change, experience psychological and spiritual growth, or contribute to society. Therefore, efforts to enhance their mental health might mistakenly be considered futile.

The subject of mental illness still makes some people uncomfortable. Some feel that getting help is a sign of weakness. Many older people, their relatives, or friends may mistakenly believe that a depressed person can quickly "snap out of it" or that some people are too old to be helped.

Once the decision is made to get medical advice, start with the family doctor. The doctor should check to see if there are medical or drug-related reasons for the depression. After a complete exam, the doctor may suggest talking to a mental-health specialist. The special nature of depression in older people has led to a new medical specialty: geriatric psychiatry.

Be aware that some family doctors may not understand aging and depression. They may not be interested in these complaints. Or, they may not know what to do. If your doctor is unable or unwilling to take your concerns about depression seriously, you may want to consult another health care provider.

If a depressed older person won't go to a doctor for treatment, relatives or friends can help by explaining how treatment may help the person feel better. In some cases, when an older person can't or won't go to the doctor, the doctor or mental-health specialist can start by participating in a phone call. The telephone can't take the place of the personal contact needed for a complete medical checkup, but it can break the ice. Sometimes a home visit can be made.

Don't avoid getting help because you are afraid of how much treatment might cost. Short-term psychotherapy, with or without medication, will work in many case and is often covered by insurance. Also, community mental health centers offer treatment based on a person's ability to pay.

There is no known cure for Alzheimer's disease. However, scientists have found some medications that may help control some of the symptoms. People with AD must work closely with their doctor to determine which drugs and activities are best for them, because reaction to medications varies for each person. Organizations such as the Alzheimer's Disease Education and Referral Center (ADEAR) and the Alzheimer's Association can provide up-to-date information, support, and advice.

Preventive Measures

Research has shown that a healthy lifestyle is more influential than genetic factors in helping older people avoid the deterioration often associated with aging. People who are physically active, eat a healthy diet, do not use tobacco, and practice other healthy behaviors reduce their risk of suffering from chronic disease and have half the rate of disability compared with those who do not. Screening to detect chronic diseases (such as diabetes or cancers of the breast, cervix, and colon) early in their course can save many lives.

Immunizations against influenza and pneumococcal disease will also reduce a person's risk for hospitalization and death from these diseases. Other preventative measures include removing tripping hazards in the home and installing grab bars, which can greatly reduce the risk of falls and fractures.

Regular exercise is a preventative measure that will enhance quality of life. Research has shown that even among frail and very old adults, mobility and functioning can be improved through physical activity. However, anyone at risk for any chronic diseases, such as heart disease or diabetes, or who smokes or is overweight, should first check with her doctor before becoming more physically active. Older adults also have special considerations:

Exercise can help older people feel better and enjoy life more, even those who think they're too old or too out of shape.

Most older adults don't get enough physical activity.

Regular exercise can improve some diseases and disabilities in older people who already have them. It can improve mood and relieve depression, too.

Staying physically active on a regular, permanent basis can help prevent or delay certain diseases (like some types of cancer, heart disease, or diabetes) and disabilities.

Plan on making physical activity a part of your everyday life. Do things you enjoy. Go for brisk walks. Ride a bike. Dance. And don't stop doing physical tasks around the house and in the yard. Trim your hedges without a power tool. Climb stairs. Rake leaves.

Safety Tips

Make sure you are exercising safely:

Start slowly. Build up your activities and your level of effort gradually. Doing too much too soon can hurt you, especially if you have been inactive.

Avoid holding your breath when exerting yourself. It may seem strange at first, but the rule is to exhale during muscle exertion and inhale during relaxation. For example, if you are lifting something, breathe out on the lift; breathe in on the release. If you have high blood pressure, pay special attention to this tip.

If you are on medications or have any conditions that change your natural heart rate, don't use your pulse rate as a way of judging how hard you should exercise. "Beta blockers," a type of blood pressure drug, are an example of this kind of medicine.

Use safety equipment, such as helmets, knee and elbow pads, and eye protection.

Unless your doctor has asked you to limit fluids, be sure to drink plenty when you are doing endurance activities that make you sweat. Many older people do not drink enough fluids, even when not exercising.

When you bend forward, bend from the hips, not the waist. If you keep your back straight, you're probably bending correctly. If you let your back "hump," you're probably bending from the waist.

Make sure your muscles are warmed up before you stretch. For example, you can do a little easy biking, or walking, and light arm pumping first.

None of the exercises you do should hurt or make you feel really tired. You might feel soreness, a slight discomfort, or a little weariness, but you should not feel pain. Physical activity and exercise will probably make you feel better.

Finally, exercising the mind is as important as keeping physically active. Recent research suggests that people who regularly engage in mentally stimulating activities such as reading, playing games, doing puzzles, listening to the radio, and visiting museums have a decreased risk of developing Alzheimer's disease. Thus the Japanese proverb "We begin aging when we stop learning" may well prove accurate.